Tarhan T, Rauschmann M
Abteilung für Wirbelsäulenerkrankungen, Orthopädische Universitätsklinik Friedrichsheim gGmbH, Marienburgstr. 2, 60528, Frankfurt am Main, Deutschland.
Orthopade. 2011 Feb;40(2):148-55. doi: 10.1007/s00132-010-1714-1.
This article gives a review of the possible revision strategies after repeated operative treatment of degenerative spinal diseases using stand-alone cages. Own clinical experiences and reports from the literature were taken into consideration. Dorsal stabilization is the main consideration for all access routes even if it can be discussed, albeit controversially, whether ventral removal of an installed cage is justified, because this contains a significantly higher perioperative risk. The increased risk of neurological complications by dorsal revision and for vascular complications by ventral access, especially at the L4/5 level must be particularly considered. Clinical data and own experience have shown that in the majority of cases an additional dorsal stabilization should be favored for revision surgery. Currently large clinical studies which deal with the revision problematic of stand-alone cages with respect to the access route are still lacking.
本文综述了使用独立椎间融合器对退行性脊柱疾病进行反复手术治疗后的可能翻修策略。文中考虑了作者自身的临床经验以及文献报道。即使对于是否有必要经前路取出已植入的椎间融合器存在争议（尽管争议较大），但后路稳定仍是所有手术入路的主要考量因素，因为经前路取出椎间融合器的围手术期风险显著更高。尤其在L4/5节段，必须特别考虑后路翻修导致神经并发症风险增加以及前路手术导致血管并发症的风险。临床数据和作者自身经验表明，在大多数情况下，翻修手术应优先选择额外的后路稳定术。目前仍缺乏关于独立椎间融合器翻修问题与手术入路相关性的大型临床研究。
